journal critique
TRANSCRIPT
Title
The title, Missed Nursing Care, is ambiguous, and lacking in information. Missed
Nursing care could mean a number of things of which are not specified. The phenomena being
studied is evident however the population under study has been omitted. More information
should be provided in the title in order to inform the reader about the article’s content.
Abstract
The abstract manages to answer the two research questions stated in the article in the first
sentence. Findings in the study are listed in the abstract, which are describing the missed nursing
care. Later in the abstract, it states that seven themes were also found but are not explicitly listed.
These themes are the reasons nurses give regarding why they do not complete nursing care. The
abstract is shorter than a typical abstract at 71 words. According to Pollit and Beck (2008),
abstracts are usually 100-200 words (Pollit and Beck, 2008, p. 72). Although brief, the major
aspects of the article are summarized in this section.
Introduction
Statement of the Problem. After reading the introduction, one can determine that by
“Missed Nursing Care” the author is trying to tell us that omissions in care can have certain
adverse effects. It is stated that literature about the specific omissions has not been completed.
Additionally, research is lacking regarding the reasons nursing staff have as to why care has been
omitted. By these statements, one can deduce what problem will be discussed in the remainder of
the article. The problem statement could be worded more clearly and directly. Due to a lack of
current literature on the subject, and the challenges we currently face in providing great nursing
care one can see the value in conducting such a study and the potential benefit to the profession
of nursing. The methods used are not mentioned in the first paragraph but in a separate section
following the research question where they are outlined clearly. The method of interviewing
participants in focus groups is consistent with the naturalistic paradigm of qualitative research.
The research tradition used is not stated in the introduction. We cannot make an assumption
about the research problem correlating with the tradition, due to lack of information.
Research Questions. The reader is able to identify the research questions in this section.
The two questions, "1) What nursing care is regularly missed on medical-surgical units in acute
care hospitals? and 2) What are the reasons nursing staff give for not completing these particular
aspects of care?" are easily identifiable and stated directly. These two questions appear to be
consistent with the study's subject. The study is entitled "Missed Nursing Care" and the questions
are essentially, what is being missed and why don't the nurses complete the care? These
questions will give insight to why nursing care isn’t getting done, relating to the conceptual
framework of the study. At this point in the article, the research tradition remains unidentified.
Literature Review. In the introduction, reference to the literature review is made. The
author states that prior research studies have shown that decreased staffing can cause an increase
in detrimental outcomes for patients. Major topics in the review are related to staffing, nutritional
risk/malnutrition, benefits of ambulation, and problems after discharge. The articles mostly
originate in nursing journals and other primary sources. There seems to be a wide variety of
topics reviewed creating a strong framework for this study. A gap in research has been identified
in the area of missed nursing care, which shows a need for more research in this area.
Conceptual Underpinnings. In the introduction, the key concepts of the study are easily
identifiable for the reader. We are told about how staffing is related to poor patient care, yet we
do not know specific examples of what entails poor patient care/missed nursing care. The author
makes it clear that we are going to explore and examine this concept and additionally, identify
why nurses do not complete the care.
Method
Protection of the participant’s rights. The methods are clearly identified in this section.
The data collection and data analysis methods are explained thoroughly. The participants, which
are LPN’s RN’s and CNA’s in the hospital were asked to commit to confidentiality. However,
they were asked to speak frankly about neglecting to perform routine aspects of their day-to-day
jobs in front of their peers. This could cause people to become uncomfortable and withhold
information from the researcher, regardless of her assurance of confidentiality. More validity and
privacy could have been obtained from a one to one interview. It would not be hard to imagine
that people would not want to participate in this study, for that reason alone.
Research Design and Tradition. The research tradition is identified in this section. The
author uses a, “grounded theory approach by which empirical data are thematically categorized
by induction.” The data was analyzed twice and similar themes were found. Data collection in
grounded theory is appropriate to be done from single or group interviews. As stated in Pollit and
Beck, “In a grounded theory study, you might be concerned if the researcher relied exclusively
on data from interviews; a stronger design might have been obtained by including participant
observations” (2008, pg. 241). The focus groups used by the interviewer were the sole means of
data collection, no time was spent in the field observing the subjects. The design appears to have
been pre-determined before any interviews had been conducted, meaning it did not unfold in the
field. There does not appear to be any reflexivity, or self-reflection about biases in this section.
The amount of contact made with the study participants was limited to only one session. The
researcher did document the subject’s statements by tape recorder and the data were analyzed
multiple times.
Sample and Setting. The sample is clearly defined. It states the job titles of the
participants and the amount of participants from each job title. Additionally, the number of focus
groups and the length of the group meeting are stated. Information regarding the hospitals where
the subjects work is included in the article. It is not clear how the researcher was able to gain
entrance to the facility. The author chose to sample nurse techs, RN’s and LPN’s which gave
diversity to her study. Also, she separated each section during the focus groups which broke
down potential communication barriers. The sample size appears to be large enough to achieve
saturation; however it is not specifically mentioned. Perhaps saturation would not have been
achieved if nurses from more hospitals were interviewed that have different barriers to patient
care.
Data Collection. The data collection method of focus group interviews prove to be
consistent with grounded theory and the naturalistic paradigm. The data from the focus groups
was tape recorded, then transcribed. This was the only method of data collection, which may
decrease the reliability of the study. It is not mentioned which questions were asked by the
researcher or who was leading the focus groups. From the length of the focus group interviews
and the sample size, it is safe to say that the data was of sufficient quantity to provide richness
and depth to the study.
Procedures. The data collection procedures are stated clearly under the data analysis
section and it could be easily replicated by another researcher. The recording procedures are
noted as well and are sufficient for this type of study. By directly recording the study
participants, there is no room to interject personal feelings or biases. It is not mentioned who
conducted the focus group or the amount of training they possessed.
Enhancement of Rigor. To enhance the validity of the data, it was analyzed by two
different researchers independently of each other. A qualitative analysis software was also used,
which should assist to eliminate opinions and influence of the researcher. From what the
researcher describes in this section, the data has been carefully handled as to avoid including
themes that were not strongly expressed in the focus groups. She includes criteria for the data to
become a theme in the data analysis section of the article.
Results/Data Analysis
The data analysis methods are described in this section. The author says she uses a
grounded theory approach, but there is no explicit reference of her coding or which grounded
theory model was utilized. She does state that, “empirical data are thematically categorized by
induction.” From the analysis emerged several themes, which the author goes on to describe.
Bias was successfully reduced by the methods described in the above section. More information
on the data analysis methods could be included.
Findings. Findings from the study are identified and explained in this section. Frequently,
quotes are used from the focus groups which support the suggested theme. The themes express to
the reader why the nurse cannot typically complete his or her nursing care. The findings of the
specific nursing tasks as well as the themes fit the original concept and framework of the study.
The questions from the beginning of the article are answered and the reader can really
understand the viewpoint of the nurse and the obstacles she faces. The quotations definitely add
an element of understanding for the reader and give good insight to the outlined themes.
Theoretical Integration. The themes and findings are described and revealed in an
organized and logical fashion. The findings of what is commonly missed relates with the themes
of why the nurse cannot complete her care. This layout follows the original framework of the
study and continues on the path of answering the two original research questions. There were no
visual aids included in the article to supplement the research findings.
Discussion
In the findings section, the aspects of missed nursing care and nurses reasons for
omissions are discussed. The focus groups identified tasks most commonly omitted which are
listed in the section. The risks of omissions are also discussed with validating sources. These
prior nursing studies add insight to the findings of commonly missed nursing care as well as the
poor outcomes associated with care omission. The use of sources is not utilized when describing
reasons for missed nursing care. The findings are easily transferrable to other hospital settings,
and the authors allude to this in the discussion. The article goes into detail about the nurse’s use
of denial, self-esteem, etc. This subject could be the start of another research project entirely.
Perhaps this should have been disregarded as this is not a reason the nurses gave as a reason for
missed nursing care, rather an inference made by the researcher.
Implications/Recommendations. In this section the researchers explain how we can
incorporate findings from their study into our practice. Their findings are discussed and the
researcher explains how the data is valuable to nurses and managers on med-surg units and how
it can help reduce the amount of missed care. The author also expresses what questions remain
unanswered and the opportunities for future research on this specific subject. Also, she mentions
aspects of her study which can be improved upon.
Global Issues
The report was well written and organized. The direct quotations from study participants
provided an insightful description of why nurses missed care. Perhaps more quotations could be
included to enrich the descriptions. After reading the article, one can tell the researcher is a
credible source. The choice of methods, data analysis, and general layout of the article shows she
is an experienced researcher. I believe that the findings are trustworthy. The reasons for missed
nursing care seem reasonable and coincide with reasons why I myself sometimes miss nursing
care on my med-surg unit. The method of data collection from interviews seems mostly reliable
with exception of participants withholding information, as I explained above. The evidence
gathered can definitely be applied by hospital management when making decisions regarding
nurse-to-patient ratios and how to provide excellent care to their patients. At the end of the
article, she states other questions that remain unanswered, which provide a basis for future
research which shows how nursing care affects the patients and their recovery.
MISSED NURSING CARE: A CONCEPT ANALYSIS
A
JOURNAL CRITIQUE
Prepared by:
GIRAY, GENN CRISTINE M.
BSN - 4
Presented to:
MARYFLOR L. CAGRO, RN, MAN
Clinical Instructor
March 2014